Application of three-fourths prone position drainage in patients with pulmonary infection and consciousness disorders after tracheotomy / 中国实用护理杂志

Objective:To analyze the application effect of three-fourths prone position drainage method in patients with pulmonary infection and consciousness disorders after tracheotomy.Methods:A total of 84 patients with consciousness disorders who were admitted to the First Affiliated Hospital of Wenzhou Medical University from January 2018 to October 2020 with pulmonary infection after tracheotomy were selected. They were divided into the control group and the observation group, there were 42 cases in each group according to random number table method. The control group received routine prone position drainage for pulmonary infection after tracheotomy and the observation group was given three-fourths prone position drainage method. The arterial partial pressure of oxygen(PaO 2), arterial partial pressure of carbon dioxide(PaCO 2) before and after intervention, the drainage effect after the intervention, the absorption of pulmonary infection foci, and the time of antibiotic treatment for pulmonary infection during the patients′ hospitalization were compared between the two groups. Results:After the intervention, PaO 2 and PaCO 2 were (91.87 ± 7.21), (35.34 ± 3.28) mmHg(1 mmHg=0.133 kPa) in the observation group, and (85.23 ± 7.90), (43.41 ± 3.39) mmHg in the control group, the differences between the two groups were statistically significant ( t=-4.02, 11.09, both P<0.05). After the intervention, the apparent rate, effective rate, and ineffective rate were 78.57%(33/42), 19.05% (8/42), 2.38% (1/42) in the observation group,and 33.33% (14/42), 45.24% (19/42), 21.43% (9/42) in the control group. The drainage effect of the observation group was better than that of the control group, and the difference was statistically significant ( Z=-4.28, P<0.05). After the intervention, the complete absorption rate of the pulmonary infection foci and the time taken to treat pulmonary infection with antibiotics during hospitalization were 59.52% (25/42), (10.67 ± 2.70) d in the observation group, and 35.71%(15/42), (13.51 ± 3.46) d in the control group, the differences were statistically significant ( χ2=4.77, t=4.19, both P<0.05). Conclusions:The three-fourths prone position drainage method has significant application effect in patients with pulmonary infection and consciousness disorder after tracheotomy. It can effectively improve the drainage effect, improve oxygenation, promote the absorption of lung infections, and shorten the antibiotic treatment time.

Effect of endoscopic minimally invasive surgery on thyroid tumors and its influence on serum IL-6, cortisol and norepinephrine / 中国基层医药

Objective To investigate the effect of endoscopic minimally invasive surgery on thyroid tumors,and its influence on serum interleukin-6 (IL-6),cortisol (Cor) and norepinephrine (NE).Methods Eighty-two patients with thyroid tumors admitted to Tianning Hospital of Wenzhou from January 2016 to January 2019 were randomly divided into laparoscopic group (41 cases) and traditional group (41 cases) according to the digital table.Traditional thyroidectomy was performed in the traditional group,and laparoscopic minimally invasive surgery was performed in the laparoscopic group.The operative indicators and complications,pain at 24 and 48 hours after operation,and serum levels of IL-6,Cor and NE before and after operation were compared between the two groups.Results The amount of bleeding during operation [(25.46 ±7.82)mL] and the amount of drainage after operation[(73.24 ± 13.25) mL] in the laparoscopic group were less than those in the traditional group [(53.21 ± 9.97) mL and (107.38 ± 16.52)mL],the length of incision [(3.04 ± 0.45) cm] in the laparoscopic group was shorter than that in traditional group [(7.18 ±0.76) cm],and the operation time [(67.84 ± 15.46) min] in the laparoscopic group was shorter than that in traditional group [(98.73 ±25.31) min],the differences were statistically significant(t =14.023,10.323,30.014,6.669,all P ＜ 0.05).The incidence of postoperative complications in the laparoscopic group (4.88 ％) was lower than that in the traditional group (26.83 ％) (x2 =7.405,P ＜ 0.05).The VAS scores of the laparoscopic group at 24h [(3.64 ±0.82) points] and 48h [(2.53 ±0.57) points] after operation were lower than those of the traditional group [(5.37 ± 1.29) points and (3.70 ± 0.81) points] (t =7.247,7.564,all P ＜0.05).The serum levels of IL-6,Cor and NE in the two groups at 24 hours after operation were higher than those before operation (all P ＜ 0.05).The serum levels of IL-6 [(49.98 ± 10.21) ng/L],Cor [(125.63 ±17.68)ng/mL] and NE [(167.86 ± 13.42) ng/L] in the laparoscopic group 24 hours after operation were lower than those in the traditional group [(83.25 ± 14.62) ng/L,(167.51 ± 25.47)ng/mL and (209.81 ± 17.86) ng/L](t =11.947,8.649,12.024,all P ＜ 0.05).Conclusion Endoscopic minimally invasive surgery is effective in the treatment of thyroid neoplasms,which has little effect on stress response and can relieve pain and reduce postoperative complications.

Therapeutic value of endoscopic ultrasonography-guided hepaticogastrostomy for high malignant biliary obstructive jaundice / 中华消化内镜杂志

Objective@#To study the therapeutic value of endoscopic ultrasonography-guided hepaticogastrostomy(EUS-HG) for patients with high malignant biliary obstructive jaundice.@*Methods@#A total of 56 patients with high malignant obstructive jaundice hospitalized at the Second Affiliated Hospital of Nanjing Medical University and the Second Affiliated Hospital of Xuzhou Medical University from January 2014 to December 2017 were included in the study. There were 29 males and 27 females with median age of 72 (60-82) years. Patients were randomized into two groups according to the random number table, the EUS-HG group (n=20) treated with EUS-HG and the percuteneous transhepatic cholangiodrainge(PTCD) group (n=36) treated with PTCD. The operative success rate, curative effect, complications and operation cost were compared between the two groups, and the median unblock period of plastic double pig tail stent was observed.@*Results@#(1)The success rates were 100% in both groups. (2) Preoperative and one-month postoperative levels of the following were tested and compared. Levels of total bilirubin were 362.15±138.27 μmol/L, 56.85±28.57 μmol/L in the EUS-HG group and 356.47±130.69 μmol/L, 60.93±25.79 μmol/L in the PTCD group, respectively. Levels of alkaline phosphatase were 896.57±357.29 U/L, 146.59±48.63 U/L in the EUS-HG group and 883.65±364.32 U/L, 151.57±49.73 U/L in the PTCD group, respectively. Levels of alanine aminotransferase were 252.36±38.77 U/L, 60.29±31.57 U/L in the EUS-HG group and 246.26±32.57 U/L, 62.56±32.87 U/L in the PTCD group. Levels of aspartate aminotransferase were 259.37±30.64 U/L, 62.28±26.58 U/L in the EUS-HG group and 242.37±29.52 U/L, 60.28±29.57 U/L in the PTCD group, and there was no significant difference between the two groups (P>0. 05). CRP levels were 52.57±31.95 mg/L, 16.95±8.77 mg/L in the EUS-HG group and 53.42±35.79 mg/L, 25.13±14.77 mg/L in the PTCD group (P<0.05). (3)There was significant difference in remission rate of anorexia and abdominal distension between the two groups [80.0%(16/20) VS 52.8%(19/36), P<0.05]. There was no significant difference in symptom relief of jaundice, pruritus or abdominal pain between the two groups [90.0%(18 /20)VS 91.7%(33/36), P>0.05]. (4) The incidence of total complications in the EUS-HG group (20.0%, 4/20) was significantly lower than that in the PTCD group (47.2%, 17/36, P<0.05). (5)The cost of operation in the EUS-HG group (22 685.26±2 356.16 yuan) was slightly higher than that in the PTCD group (20 529.57±4 135.63 yuan, P>0.05). (6) The median unblock period of double pig tail plastic stents in EUS-HG group patients was 102 days.@*Conclusion@#EUS-HG is a safe and effective method for the treatment of high malignant biliary obstructive jaundice. It can be used as the first choice for treatment after failure of conventional ERCP.

Nursing care of infantile acute necrotizing fasciitis treated with vacuum sealing drainage and continuous irrigation / 中国实用护理杂志

Objective To conclude the practical nursing experiences of the infantile actue necrotizing fasciitis treated with vacuum sealing drainage(VSD) and continuous irrigation.Methods 21 cases of the infantile actue necrotizing fasciitis treated with with VSD and continuous irrigation were reviewed from January 2009 to December 2014.The nursing experiences of observation for the state of the illness,the safety management of VSD,the management of medication,mental nursing and health education were summarized.Results 21 infants all recovered and were discharged.Postoperative follow up 6 months later were conducted.No obvious disabilities of the extremities were found.Among them,8 cases were treated with VSD and continuous irrigation for 2 weeks and then had routine wound dressing changing for 10 days,the wound almost healed when discharged.13 cases were treated with VSD and continuous irrigation for one week and then had routine dressing changing for 12 to 13 days.The wound healed when discharged.No skin necrotizing,no scar of the incision and no other complications were detected.Conclusions Using VSD and continuous irrigation to treat the actue necrotizing fasciitis in infants are of great significance for the nurses to reduce the postoperative complication and promote rehabilitation doing as follows:turning over with the postoperative nursing of VSD in a standard manner,observation and management of the incision area,maintenance of the irrigation and VSD;observation and assessment of the infant's condition,management of the medication,mental nursing and health education.

Effect of modified postural drainage for treating pulmonary infection of senile patients with gastric cancer / 中国实用护理杂志

Objective To explore clinical effect of modified postural drainage for treating pulmonary infection of senile patients with gastric cancer.Methods 107 cases of patients with gastric cancer were randomly divided into two groups:control group (n =53) and treatment group (n =54),which were respectively treated by routine postoperative therapy and nursing measures and modified postural drainage based on these routine measures,and compared daily amount of expectoration sputum,positive cases of sputum culture,restore time of postoperative blood test,postoperative fever time,cases of pulmonary infection on the postoperative tenth day and length of stay.Results Daily amount of expectoration sputum of patients in treatment group was significantly higher than that of control group [(185.7 ± 23.7) ml vs.(99.7 ± 17.6) ml] (P ＜ 0.05).However,restore time of postoperative characters of blood test [white blood cell count (2.9±0.9) d vs (5.0±0.7)d,C-reaction protein (35±0.7)d vs.(7.4±0.6) d],postoperative fever time [(1.9±0.5) d vs.(3.6±1.4) d],cases of atelectasis (5 cases vs.19 cases) and length of stay [(1.9±0.5) d vs.(3.6±1.4) d] were respectively significantly less than those of control group (P ＜ 0.05).Conclusions Modified postural drainage could effectively prevent postoperative atelectasis and pulmonary infection,significantly reduced incidence of postoperative atelectasis of senile patients with gastric cancer operation,and so it was worthy of clinical application.

Segurança e efetividade da fisioterapia respiratória em abscesso pulmonar: estudo de casos / Safety and effectiveness of chest physiotherapy in lung abscess: a two-case study

O abscesso pulmonar é uma lesão necrótica geralmente devida a germes piogênicos. A fisioterapia respiratória (FR) é indicada, porém há poucos relatos na literatura, não havendo consenso quanto ao uso e às técnicas de FR para esse caso. O objetivo deste estudo de dois casos foi verificar a segurança e efetividade da FR no tratamento do abcesso pulmonar. O caso 1 foi um paciente de 30 anos, internado; a terapia consistiu em posicioná-lo em Trendelenburg semi-lateral direito para ventral por 30 minutos, três vezes ao dia, com saída de grande quantidade de secreção. Após 5 dias, o radiograma de tórax demonstrou redução de 90% do nível hidroaéreo, verificando-se o esvaziamento completo do abscesso após 14 dias de internação. O caso 2 foi uma paciente de 28 anos igualmente com diagnóstico de abscesso pulmonar, também tratada com drenagem postural, nos mesmos posicionamento e freqüência que o caso 1, sendo drenada grande quantidade de secreção amarelada e fluida. Após 7 dias de tratamento evidenciou-se redução importante do nível líquido do abscesso pulmonar. Conclui-se que a drenagem postural isoladamente é uma técnica de fisioterapia efetiva e segura no tratamento do abcesso pulmonar.

Lung abscess is a necrotic lesion mostly caused by pyogenic germs. Chest physical therapy (CPT) is indicated, but there are few studies available and no consensus on CPT use and techniques for theses cases. The purpose of this study was to assess safety and effectiveness of postural drainage in treating lung abscess in two cases. Patient 1, male, 30 years old, was laid in Trendelenburg, in semi-lateral to ventral decubitus for 30 minutes, three times a day. After five days of therapy, X-ray showed a 90% decrease of sputum, and on the 14th day full drainage was achieved. Case 2 was a female patient, 28 years old, treated at the same position and frequency as case 1. After seven days of therapy, exams showed a great decrease of pus from the abscess. It may thus be said that postural drainage alone is a safe and effective chest physical therapy technique for treating lung abscesses.

The clinical application of percutaneous catheter external draining of pancreatic pseudocyst guided by CT / 中华放射学杂志

Objective To explore the clinical application and value of percutaneous treatment of pancreatic pseudocysts guided by CT.Methods The percutaneous external draining of pancreatic pseudocyst caused by various causes was performed under CT guidance in 29 cases, including 21 males and 8 females, age from 22 to 71 years, average (48.2?13.6) years. After the point, the angle,and the depth of puncture were measured on CT images, pseudocyst puncture and catheterization of external draining were made and followed up. Results 30 procedures of puncture in 29 lesions were done, the successful rate was 100%. Puncture path included frontal in 17 cases(18 times of puncture), lateral in 8 cases ; back in 4 cases, and 30 drainage catheters were placed. All cases were followed up except one case, follow up time ranged from 1 to 20 months [average (8 07?4 04) months]. Following disappearance of pseudocyst, catheters were extracted in 19 cases except 2 cases with pseudocyst recurrance. Follow up time from 4 to 14 months[average (8.29?4.03) months]. 5 cases had surgerical operations again after draining 1-4 months, 4 cases were still being followed up. The effective rate of therapy was 65.52%(19/29). Conclusion The technique of percutaneous catheter external draining of pancreatic pseudocyst guided by CT is mildly invasive and simple, and has high successful rate.